Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | A-8723-0002-A | IL |
NPI | 1003356742 |
---|---|
Provider Name | Dr. Anthony Dillard SR. |
First Address | Calumet City, IL 60409-2107 |
Second Address | Elgin, IL 60120-4523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 28/02/2017 |